2005 SAGES Abstracts

POSTER ABSTRACTS
P070–Bariatric Surgery
AN ANALYSIS OF GASTROJEJUNOSTOMY STRICTURES IN
222 CONSECUTIVE PATIENTS UNDERGOING LAPAROSCOPIC
ROUX-EN-Y GASTRIC BYPASS, John C Lohlun MD, Piotr J
Gorecki MD, Won Sohn MD,Rahel Bernstein,Leslie Wise MD,
Departments of Surgery and Gastroenterology, New York
Methodist Hospital, Brooklyn, New York, USA
Introduction: Stenosis of the gastrojejunostomy after Roux en
Y gastric bypass is a complication that has been reported with
all surgical techniques used to construct the gastroenterostomy
and occurs between 2 to 27% of patients after gastric
bypass. The incidence, management, and outcomes of gastrojejunostomy
strictures in 222 consecutive patients undergoing
laparoscopic Roux-en-Y gastric bypass were analyzed.
Materials and Methods: 222 consecutive patients underwent
laparoscopic Roux-en-Y gastric bypass at our institution
between August 2001 and August 2004. Data was entered
prospectively into the database. The gastrojejunostomy was
performed in all patients with the same technique using a 25-
mm circular stapler inserted transorally. Anastomotic stricture
was defined as a combination of symptoms of progressive
inability to tolerate solid food with the endoscopic finding of
stenosis that did not permit the passage of a 9 mm endoscope.
Results: Sixteen patients suspected to have stenosis of the
gastrojejunostomy underwent 24 upper gastrointestinal endoscopies.
The average interval between surgery and the diagnosis
of stricture was 6 weeks (2-22 weeks) and the mean time
from the onset of symptoms to the time of endoscopy was 1.3
weeks (0.5 to 6.5 weeks). Stricture was found in 14 out of 222
patients (6.3%). Two patients suspected to have stenosis were
diagnosed with marginal ulceration. Two patients with diagnosed
stricture had concomitant marginal ulceration. The average
size of the stenotic anastomosis was 4.6 mm (3mm ? 7
mm). All patients with stricture underwent balloon dilatation at
the time of endoscopy. Eight patients required one dilatation,
four patients required two dilatations, and two patients
required three dilatations. Four patients were admitted to hospital
for IV hydration. There were no complications associated
with dilatations and no need for reoperation in any of the
patients. There were no deaths in these 14 patients. All
patients with stricture resumed tolerance to solid food and no
further recurrences were noted at the mean follow up of 20.35
months (2 ? 37 months).
Conclusion: Balloon dilatation is an effective treatment for gastrojejunostomy
stenosis. Controlled radial expansion with cessation
of further dilatation if any evidence of trauma becomes
evident, is important to avoid perforation. It is not necessary to
dilate the anastomosis beyond 9 mm to achieve a satisfactory
long-term result.
P071–Bariatric Surgery
RESOLUTION OF OBSTRUCTIVE SLEEP APNEA SYMPTOMS
AFTER LAPAROSCOPIC GASTRIC BYPASS, Mario Longoria
MD, Trung Bui MD,Sara Chalifoux BS,Ninh T Nguyen MD,
University of California, Irvine Medical Center, Orange, CA
Introduction: Obstructive sleep apnea is a common respiratory
condition in the morbidly obese. Medical therapy includes the
use of continuous positive airway pressure (CPAP); however,
weight reduction is the ideal treatment for obese patients suffering
from obstructive sleep apnea. The aim of this study was
to characterize the effect of weight loss after Roux-en-Y gastric
bypass on the symptoms of sleep apnea.
Methods: The charts of 24 morbidly obese patients with documented
obstructive sleep apnea based on sleep polysomnography
were reviewed for demographics, the use of CPAP, and
weight loss. Symptoms of sleep apnea were measured preoperatively
and postoperatively based on the scores of Epworth
sleepiness scale (ESS). An ESS score greater than 7 was considered
abnormal.
Results: There were 19 females and 5 males with a mean age
of 41 years. The mean preoperative body mass index
decreased from 46 kg/m2 preoperatively to 33 kg/m2 at 6
months postoperatively. The mean preoperative ESS
decreased from 12 ± 2 preoperatively to 4 ± 1at 6 months postoperatively
(p